Twenty to 40 year follow up of infantile hiatal hernia

Area of Science:

• Gastroenterology
• Pediatric Surgery
• Clinical Medicine

Background:

• Hiatal hernias diagnosed in infancy or early childhood can persist into adulthood.
• Long-term clinical outcomes and radiological findings of these cases require further investigation.
• Understanding the natural history of pediatric hiatal hernias is crucial for adult patient management.

Purpose of the Study:

• To evaluate the clinical and radiological characteristics of gastro-oesophageal reflux in adults with a history of childhood hiatal hernia.
• To assess the long-term impact of childhood hiatal hernia on adult gastrointestinal symptoms and treatment needs.
• To identify potential risk factors for persistent symptoms and complications like Barrett's oesophagus.

Main Methods:

• A cohort of 118 adult patients (minimum age 20) with a history of childhood hiatal hernia was interviewed.
• Barium meal examinations were conducted in 96 patients to assess radiological findings.
• Patient data included surgical history, symptom frequency (heartburn), and antacid consumption.

Main Results:

• Hiatal hernia persisted in 53% of non-surgically treated patients; 46% reported monthly heartburn, with few severe cases.
• Heartburn was more frequent in patients with radiological evidence of reflux on barium meal.
• Adults with a history of effective childhood treatment consumed fewer antacids (20% vs. 46%).
• Two patients developed Barrett's oesophagus, suggesting a need for endoscopic surveillance.

Conclusions:

• Persistence of hiatal hernia in adulthood is common, but significant symptoms are infrequent in non-surgically treated individuals.
• Effective childhood treatment correlates with reduced adult antacid use for heartburn.
• The occurrence of Barrett's oesophagus highlights the importance of considering endoscopic screening in this patient cohort.